Friday, April 22, 2016

The nineteenth century, and particularly the Victorian
years, saw enormous advances in medicine. New procedures were developed,
standards of cleanliness improved and for the first time pain relief was
possible with the development and use of anaesthetics. Progress, however, did not come cheaply. Reputations were made but,
equally, reputations were lost. For every group that argued for progress, there
was another group to argue against it.

On 7 April 1853 Queen Victoria was delivered of a son,
Prince Leopold. During the birth, she was anaesthetised with chloroform by Dr
John Snow.* “The inhalation lasted fifty-three
minutes. The chloroform was given by on
a handkerchief, in fifteen minim doses.”** Four years later, in 1857, John Snow was in attendance again and again employed chloroform
in the delivery, this time, of Princess Beatrice.

The Queen's decision to have chloroform administered
during the birth was not made lightly. There
had been discussions as early as 1848, with Prince Albert who strongly
supported the use of the anaesthetic, and the Queen’s physicians, who
apparently had reservations about it. While it had not been used in the
delivery of either Princess Louise (1848) or Prince Arthur (1850), when it was
finally employed for the birth of the Queen’s seventh child, Her Majesty was
delighted. Writing in her Journal,
she had nothing but praise. “Dr Snow administered ‘that blessed Chloroform’
& the effect was soothing, quieting & delightful beyond measure.”
Indeed, as she noted, she had “never recovered better.”

Just a little over a month after the Queen gave birth
to Prince Leopold, an article appeared in the Lancet, criticising the
administration of chloroform to the Queen.
Although not named in the article, it was clearly an attack on Dr John
Snow by the owner/editor of the journal, Thomas Wakley. The article was mildly
hysterical in tone claiming that

Intense
astonishment … has been excited throughout the profession by the rumour that
her Majesty during her last labour was placed under the influence of chloroform,
an agent which has unquestionably caused instantaneous death in a considerable
number of cases. … we could not imagine that any one had incurred the awful
responsibility of advising the administration of chloroform to her Majesty
during a perfectly natural labour with a seventh child.

Much of the literature related to the consequences of
the use of chloroform in the birth of Prince Leopold emphasised the wider
acceptance of anaesthetics as a result. While the Royal approval of the use of chloroform
might have provided what was at least an informal imprimatur, not all of the
medical profession was accepting of the use of anaesthetics, especially
chloroform, in childbirth. As TheLancet went on to point
out, certainly incorrectly in the face of the Queen’s own statement, the
so-called administration of chloroform was all a pretence employed because
“some officious meddlers about the Court so far overruled her Majesty’s
responsible professional advisers as to lead to the pretence…”

H and T Connor have suggested that it is unlikely that
lay opinion was influenced since the press reports of the birth did not, in
general, mention the use of anaesthetics. That may indeed have been the case, but by the time of the Queen’s
accouchement, the use of chloroform in parturition was common enough for one
correspondent to write to the Association Medical Journal shortly
after the Queen’s delivery,

Your
announcement, a few weeks ago, of the Queen’s accouchement under chloroform and
that, under no other than ordinary circumstances, the royal child-birth had
been treated by anaesthesia, doubtless gave rise to considerable emotion and excitement
both in the professional and the female world. … For some time, however, before
this, it was well known that, in certain districts, the married—especially the
young married—women, even of respectable society, had been in much agitation
respecting the recent discussions upon chloroform, and had become so solicitous
for its administration in their own cases…

The debate continued and seems to have accelerated
after the Queen gave birth to her seventh child. The all-male medical profession engaged in rather
convoluted arguments to justify the pain of childbirth. To offer succour to women in labour was, some
argued, “meddling or interference” and could not be defended.

If labour be
undeniably a physiologic process for the birth of human offspring, and if
anatomy and physiology have proved that this process cannot be obtained without
fulfilling the Divine enunciation, ‘that in sorrow and pain woman should bring
forth’, the whole of this being notwithstanding perfectly consistent with the
health of mother and child,--what doctrine can be an excuse for mischievous
meddling with such a miracle of contrivance?

Some of the criticism was undeniable valid. There had been deaths with the use of
chloroform. Indeed, its popularity was such as to lead to inexperienced, and
even those totally untrained in medical procedures, to act as anaesthetists.
Beyond that, even those with a degree of medical training were not necessarily
conversant with the best means of administering chloroform and in some cases
may have been dangerously enthusiastic in its use.

John Snow, however, was meticulous and careful. He was concerned about regulating the dosage
and even developed a mask for proper administration of chloroform although this
was not used with Victoria. Instead he employed the “open-drop” method where
the chloroform was dropped onto a cloth covering the face of the Queen.

Snow was not the first doctor to use chloroform. It was first used in childbirth by James
Young Simpson, Professor of Midwifery in the University of Edinburgh, who had
discovered its properties in 1847. Simpson reported his cases in The
Lancet, detailing nine of these in the issue of 11 December 1847. In
the first case it was the mother’s second birth. “In her first confinement she
had been three days in labour, and the infant had at last been removed by
craniotomy.”*** Of
the effect of the chloroform in the first case he wrote; the patient

...did not
awake till after the placenta was removed, and then spoke of having “enjoyed a
very comfortable sleep.” She was not in any degree aware that the child was
born; and when, in a few minutes, it was brought in . . . I was a matter of no
small difficulty to persuade the astonished and delighted mother that the child … was really her own infant.

It was the work of Simpson and Snow that effectively
changed the nature of childbirth through the introduction of the use of
chloroform. Questions as to its safety
were effectively laid to rest in 1853 with its use by Queen Victoria, and by
the time of his death in 1858, at the age of 45, He had, according to Sir Peter
Froggatt,

… no deaths
in over 4000 chloroform cases, often bad risk ones, … he anaesthetised for over
30 leading London surgeons and included the Queen and members of the social and
commercial élite among his
cases …

**A minim is 1/60th of a fluid dram or about the equal of one drop.***Craniotomy involved the reduction in
the size of the unborn child’s head and was used where labour was obstructed. It was used in cases of foetal death and made
vaginal delivery possible rather than run the far greater risk of performing a
caesarean section before the advent of anaesthetics.

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About Me

I regret to advise that my husband Dr Bruce Rosen died on 19th September 2017. Many thanks to all of the followers and admirers of this site over many years.

Virginia Rosen.

Retired from active teaching since 1995, I am an Honorary Research Associate in the School of History and Classics at the University of Tasmania.

Following my retirement, I administered and taught in Summer Schools at St John's College, University of Sydney and at Jane Franklin Hall, an associated college of the University of Tasmania.

I enjoy travel and for many years spent several months a year in Europe. This included a visit to Israel, a study tour of Venice, and a river cruise from Amsterdam to Budapest. But always, always, there is Paris where, for many years I spent three months a year.

I am happy to respond, as possible, to requests for information as long as they are not anonymous and they are sent to me at bruce@tassie.org